Photography and Filming Request

Southwestern Region National Forests

Date:

Project Title:

Company: Tax ID:

Address:

Office Phone: Cell Phone:

FAX #:

Primary Contact, Title & Phone:

Backup Contact, Title & Phone:

FedEx #:

Production Date(s) and Time:

I. Production Information:Type Film, please check all that apply:

Still Photography

Commercial TV

Movie TV

Episodic Feature

Music Video

Corporate Video

Documentary

Other:

Proposed Location(s) (including size):

Set Up (date, start/stop, # of people):

Filming (date, start/stop, # of people):

Breakdown and Restoration (date, start/stop, # of people):

Alternate Filming Date:

Parking (vehicles, equipment, aircraft):

Staging (dressing rooms, catering, portable restrooms, etc.):

Stunts/Special Effects Proposed, please check which one or ones apply:

Pyrotechnics

Hazardous MaterialsWild Animals

Aerial Stunts

Riparian Area

Developed Recreation SiteOther:

Special Request Information, please check which one or ones apply:

Wilderness

Use of Aircraft

Weather

Other:

Aircraft Info Required (Tail #, Color, Make, Model, & Flight Path):

Total number of people on location:

II. Description of Proposed Filming Activity:Include a map of area, proposed ground disturbing activities, story boards and photos as needed:

III. Description of Equipment:Equipment detail, please check applicable:

Generators

Cars

Trucks

RVs

Other:

Action involving vehicles and/or equipment:

Props proposed:

Traffic and safety control/special closures measures needed (Have you obtainedwritten permission or permit to use improvements not owned by/under the jurisdiction ofthe United States Government, i.e. structures, roadways, etc. and provided a copy to theForest Service?):

***Insurance Certificate AND Insurance Policy Endorsement MUSTname the "United States as Additionally Insured" and require that thecompany WILL mail a "30 days written cancellation notification prior tothe cancellation of the insurance" to the Forest Service. A copy of BOTHdocuments MUST be provided to the Forest Service prior to filming. ***

To be Completed by Forest ServiceFees and Additional Information:

Photography/Filming Fee:

Unique Site Fee:

Total Cost:

Collection Agreement #:

Certificate of Insurance AND Endorsement Received:

Bonding Information:

Property Owner Permission Required and Obtained:

Road Encroachment Permit Required and Obtained:

Fee Schedule:Still Photography

1-10 persons $50/day

11-30 persons: $150/day30+ $250/day

Other Filming:

1-10 persons $150/day11-30 persons $200/day31-60 persons $500/day60+: $600/day